JMIR Publications

ABSTRACT

Background:

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act sets three Stages of Meaningful Use requirements for the electronic health records (EHR) Incentive Program. Health information exchange (HIE) technologies are critical in the Meaningful Use of EHRs to support patient care coordination. However, HIE use trends and barriers remain unclear across South Carolina Hospitals.

Objective:

This study aims to explore changes in the proportion of HIE participation and associated factors with HIE participation, and barriers to interoperability across hospitals in South Carolina.

Methods:

This study derived data from a longitudinal dataset of the 2014-2020 American Hospital Association Information Technology Supplement for 69 hospitals in South Carolina. The primary outcome was whether a hospital participated in local HIE activities in a year. Multiple cross-sectional multivariable logistic regression models, clustered at the hospital level and weighted by bed size, were used to identify factors associated with HIE participation across hospitals. The second outcome was barriers to sending or receiving patient health information. The frequency of hospitals reporting each barrier related to electronically sending or receiving patient health information or other financial or technical barriers to exchanging patient health information were then calculated.

Results:

Hospitals in South Carolina have been increasingly participating in HIE, from 42.9% in 2014 to 81.8% in 2020. In 2020, teaching, system-affiliated hospitals, and those hospitals with higher ratios of Medicare or Medicaid inpatient days to total inpatient days were more likely to have HIE than their counterparts. Critical Access Hospitals were less likely to participate in HIE than their counterparts reimbursed by the Prospective Payment System. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, top of which included lack of provider contacts (67.5%), difficulty in finding patient health information (67.5%), adapting different vendor platforms (65.0%), difficulty matching/identifying same patients between systems (57.5%), and some providers don’t typically exchange patient data (57.5%).

Conclusions:

HIE participation has been widely adopted in South Carolina. These findings highlight the need to incentivize optimization of HIE and seamless information exchange across facilities by facilitating and implementing standardization of health information across various HIE systems and by training HIE stakeholders about privacy/security regulations to ensure smooth, safe, and secure patient care transitions. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information. Clinical Trial: NA